RESUMO
BACKGROUND: Performing stem cell collection after mobilization chemotherapy was a well-balanced strategy between anti-tumor effect and efficient collection of CD34+ cells, but deep and prolonged nadir exposed patients to risk of febrile neutropenia. Febrile neutropenia was known to be associated with lower yields of CD34+ cells, but quantitative data referring to association between yields of CD34+ cells and severity of neutropenia was lacking. We hypothesized that D-index, which was developed for quantitative evaluation of severity of neutropenia especially in the field of hematologic malignancies, could predict yields of CD34+ cells. METHODS: We performed a single center, retrospective analysis of patients with relapsed or refractory aggressive lymphoma who were mobilized with ESHAP or modified ESHAP. We evaluated the association between yields of CD34+ cells at first apheresis and D-index. RESULTS: Thirty-six patients were included, and we demonstrated that yields of CD34+ cells from patients with higher D-index were significantly lower than those from patients with lower D-index. Multivariate linear regression analysis and logistic regression analysis also demonstrated the significant predictive power of D-index. Further, D-index was significantly correlated to platelet count before starting mobilization chemotherapy. Platelet count was known to predict yields of CD34+ cells, and combination of platelet count and D-index could identify patients with lowest CD34+ yields. CONCLUSION: D-index could predict yields of CD34+ cells and it seemed that its predictive power was not less than that of platelet count. Prospective studies including more heterogeneous patients were needed to validate our study.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Remoção de Componentes Sanguíneos , Linfoma/terapia , Adolescente , Adulto , Idoso , Antígenos CD34 , Cisplatino/uso terapêutico , Citarabina/uso terapêutico , Etoposídeo/uso terapêutico , Feminino , Humanos , Linfoma/patologia , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos , Terapia de Salvação , Índice de Gravidade de Doença , Adulto JovemAssuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Hiperplasia do Linfonodo Gigante/complicações , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Receptores de Interleucina-6/antagonistas & inibidores , Adulto , Anticorpos Monoclonais Humanizados/administração & dosagem , Hiperplasia do Linfonodo Gigante/tratamento farmacológico , Creatinina/urina , Esquema de Medicação , Glomerulosclerose Segmentar e Focal/etiologia , Glomerulosclerose Segmentar e Focal/urina , Humanos , Interleucina-6/antagonistas & inibidores , Masculino , Proteinúria/etiologia , Proteinúria/urinaRESUMO
BACKGROUND: Epstein-Barr virus-positive mucocutaneous ulcer is one of the mature B-cell lymphoproliferative diseases occurring in patients with immune dysfunction including those with immunosuppressive treatment such as methotrexate. CASE PRESENTATION: A Japanese elderly man in his 80s with rheumatoid arthritis on methotrexate was admitted to our hospital complaining persistent pharyngeal pain. Laboratory tests revealed severe pancytopenia, elevated C-reactive protein, and increased creatinine levels. An otolaryngological examination showed ulceration of the right tonsil, from which diagnostic biopsy was performed. The diagnosis of Epstein-Barr virus-positive mucocutaneous ulcer was made and bone marrow aspiration revealed hypocellularity and megaloblastic changes. Pancytopenia was improved after discontinuing methotrexate, and repeated bone marrow aspiration test revealed recovery of normal cellularity and disappearance of dysplasia, confirming the diagnosis of methotrexate intoxication. Tonsil ulcer was improved only with discontinuation of methotrexate, which strongly supported the diagnosis of EBV-MCU. CONCLUSION: Our case suggested that even this best prognosis form of lymphoproliferative disease could lead to fatal complications if not appropriately managed.
Assuntos
Artrite Reumatoide , Infecções por Vírus Epstein-Barr , Metotrexato , Humanos , Metotrexato/efeitos adversos , Masculino , Infecções por Vírus Epstein-Barr/complicações , Artrite Reumatoide/tratamento farmacológico , Idoso de 80 Anos ou mais , Úlcera/induzido quimicamente , Imunossupressores , Transtornos Linfoproliferativos/induzido quimicamente , Herpesvirus Humano 4/isolamento & purificação , Pancitopenia/induzido quimicamente , Tonsila Palatina/patologiaAssuntos
Medula Óssea/patologia , Evolução Clonal , Leucemia Linfocítica Crônica de Células B/patologia , Leucemia Plasmocitária/patologia , Linfocitose/patologia , Idoso de 80 Anos ou mais , Anemia Hemolítica Autoimune/complicações , Anemia Hemolítica Autoimune/tratamento farmacológico , Antígenos CD/análise , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/administração & dosagem , Células Clonais/química , Células Clonais/patologia , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Progressão da Doença , Feminino , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Linfocitose/complicações , Melfalan/administração & dosagem , Prednisolona/efeitos adversos , Prednisolona/uso terapêutico , Rituximab/administração & dosagem , Rituximab/efeitos adversos , Rituximab/uso terapêuticoAssuntos
Doença de Hodgkin/diagnóstico por imagem , Encefalite Límbica/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Adulto , Feminino , Doença de Hodgkin/complicações , Doença de Hodgkin/terapia , Humanos , Encefalite Límbica/complicações , Encefalite Límbica/terapia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/terapiaRESUMO
Although anti-interleukin-6 therapy with tocilizumab and siltuximab is recommended for multicentric Castleman's disease (MCD), burdens caused by frequent hospital visits and high drug payments is an issue to be considered. Although glucocorticoid monotherapy might be less effective compared to these agents, substantial proportions of patients can be successfully treated for years. Therefore, we conducted a retrospective analysis of Castleman's disease patients to explore predictors of glucocorticoid responsiveness and revealed that higher hemoglobin and/or lower C-reactive protein levels before starting glucocorticoid monotherapy were associated with lower probability of requirements for second-line treatment among patients initially treated with glucocorticoid. We concluded that glucocorticoids had a potential to induce sustained disease control for indolent MCD patients with specific clinical characteristics.